Confronting Violence Health Care Workplace Violence

Most people think of hospitals as places for healing. But the threat of violence -- which can take many forms -- can be a daily reality for nurses and other health care workers, creating a compelling need to properly address the issue, says Kate McPhaul, PhD, MPH, RN, assistant professor and program director for the University of Maryland Baltimore of Nursing’s Community/Public Health Nursing master’s specialty.

The issue gained national attention in September 2010 when a doctor at nearby Johns Hopkins Hospital was shot by the distraught son of a surgical patient. The shooter went on to kill both his mother and himself. The Hopkins doctor recovered.

“Health care workers face a unique situation in that violence is coming from our patients and visitors due to clinical reasons such as mental illness or head injury,” says McPhaul. “Workplace violence also has an effect on job satisfaction, patient care quality, and nurse turnover.”

With this in mind, McPhaul and other school faculty members are advising in the development of an evidence-based online training and educational resource that will be hosted on the National Institute for Occupational Safety and Health’s (NIOSH) website.

“This program will set the standard on how health care workers should be trained to prevent violence, and it’s exciting that School of Nursing faculty members are playing such a major role,” said McPhaul.

McPhaul says that the workplace violence issues that nurses and other health care workers face go beyond physical risks. “Nurses also care about verbal abuse and hostility from patients, visitors, and even colleagues: incivility and bullying.” The most common violent situations are those in which staff members are verbally assaulted by frustrated, disgruntled, or unhappy patients and visitors, she says.

“Hospitalizations create high stress for families, not to mention pain from surgery, medication interactions, and other factors that would make someone agitated or hostile,” she said. “Less frequent but more dangerous are the confrontations with those who have a history of violence, which may or may not be known by the nurse, and who are under the influence or mentally unstable. Violent patients have physically assaulted staff resulting in severe bruises and contusions, and broken bones.”

McPhaul says that the online training content under development will include interactive and video elements using actors, to help learners better recognize and react to verbal violence.

“Many staff feel that verbal hostility is ‘part of the job’ and that nothing can be done about it,” she said. “We hope that once staff recognize verbal abuse, hostility, and verbal assaults and threats, they will be more likely to report it and less likely to tolerate it.”

The training program will offer methods for dealing with violent situations, including verbal de-escalation, patient behavioral contracts, earlier use of security, controlled

access to the building or ward, calling for assistance, and using an alarm system. While the program will initially focus on nurses, it will be as inclusive as possible to address the needs of all health care workers, McPhaul says.

The advantage of an online program backed by a federal agency (NIOSH is part of the Centers for Disease Control and Prevention), McPhaul says, is that it can

be equally accessible to all health care facilities. Hospitals needn’t front the cost of developing the program themselves, and can rest assured that the federally-backed program will incorporate mandated safety standards.

McPhaul says that the program will aid existing hospital staff, new employees, and nursing students, and that nurses may be able to earn continuing education requirements.

“Any employer or nursing organization with an interest in patient and staff safety will benefit,” she says. “This training is especially critical for nurses in the ER and mental health wards, for their safety. In the end, safety is safety -- whether it’s for staff, patients, or visitors. All should have equal priority.”

After the training program is complete, there will be a piloting and evaluation process by nurses, hospitals, and professional organizations, among others, says McPhaul. She aims for the program to be online by early 2012.


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